1
|
Xu Q, Zhou F, Yang D. Digital subtraction angiography-guided peripheral nerve stimulation via the foramen rotundum for refractory trigeminal postherpetic neuralgia: a case report and literature review. Front Neurol 2024; 15:1353882. [PMID: 38487331 PMCID: PMC10939014 DOI: 10.3389/fneur.2024.1353882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Postherpetic neuralgia (PHN) is a debilitating complication of varicella-zoster virus infection. This case report presents a novel approach to treating refractory trigeminal maxillary postherpetic neuralgia using digital subtraction angiography (DSA)-guided peripheral nerve stimulation via the foramen rotundum. A 72-year-old female with severe, treatment-resistant pain underwent this intervention. The results demonstrated the disappearance of tactile allodynia, a significant reduction in oral analgesic requirements, and no observed complications or side effects during a 3-year follow-up period. This case highlights the potential effectiveness of DSA-guided peripheral nerve stimulation using a new dorsal root ganglion (DRG) stimulator as an alternative therapy for refractory trigeminal postherpetic neuralgia (TPHN).
Collapse
Affiliation(s)
- Qingbang Xu
- Department of Pain Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Fangyuan Zhou
- Department of Pain Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| | - Dong Yang
- Department of Pain Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, China
| |
Collapse
|
2
|
Basha AKMM, Simry HAM, Abdelbar AE, Sabry H, Raslan AM. Outcome of Surgical Treatments of Chronic Pain Caused by Trigeminal Neuropathy. World Neurosurg 2023; 170:e57-e69. [PMID: 36273728 DOI: 10.1016/j.wneu.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Trigeminal neuropathy represents a subset of several facial pain syndromes that are difficult to diagnose and treat. Although many surgical modalities are available, outcomes remain suboptimal. The aim of this study is to present our experience in management of trigeminal neuropathy with a focus on the effectiveness and long-term efficacy of the different surgical procedures. METHODS A single-center retrospective cohort study was conducted from December 2012 until February 2020. RESULTS Twenty-eight patients (19 females, 9 males) were included in this study. They had 40 surgical interventions. At last follow-up, 1 patient (33.3%) treated by spinal cord stimulation (SCS) had no pain recurrence and 2 patients (66.6%) had their devices removed because of therapeutic failure. Median time to pain recurrence after SCS was 19.5 months (interquartile range [IQR], 29.79 months). Six patients were treated with peripheral nerve stimulation (PNS). At last follow-up, 2 patients had satisfactory pain relief, whereas half of the patients had no improvement. For the 17 patients treated with computed tomography-guided trigeminal tractotomy/nucleotomy, true failure occurred 7 times in 6 patients. Median time to pain recurrence was 5.6 months (IQR, 6.2). Of the 6 patients treated with caudalis DREZ, 3 (50%) had satisfactory pain relief for >1 year and the median time to pain recurrence was 3.9 months (IQR, 29.53). CONCLUSIONS Trigeminal neuropathy is a difficult to treat entity of facial pain syndromes. The long-term efficacy of available interventions does not meet patients' satisfaction. More organized prospective studies with longer follow-up are needed to define the patient population best served by each surgical modality.
Collapse
Affiliation(s)
| | | | | | - Hatem Sabry
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Ahmed M Raslan
- Department of Neurosurgery, Oregon Health and Science University, Oregon, Portland, USA
| |
Collapse
|
3
|
Sarica C, Iorio-Morin C, Aguirre-Padilla DH, Paff M, Villeneuve SA, Vetkas A, Yamamoto K, Samuel N, Milano V, Loh A, Santyr B, Zemmar A, Lozano AM, Hodaie M. Clinical outcomes and complications of peripheral nerve field stimulation in the management of refractory trigeminal pain: a systematic review and meta-analysis. J Neurosurg 2022; 137:1387-1395. [PMID: 35180702 DOI: 10.3171/2021.12.jns212869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Peripheral nerve field stimulation (PNFS) is a tool in the armamentarium of treatment options for trigeminal pain. The efficacy of this modality in mitigating trigeminal pain remains unclear. The aim of this study was to examine the existing literature on PNFS and elucidate pain score outcomes associated with its use in patients with trigeminal pain. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA framework. The PubMed, Web of Science, and Scopus databases were queried on June 10, 2020. Studies reporting pain outcomes in more than 5 adult patients treated with PNFS for facial pain were included. The primary outcome of the study was the mean difference in the visual analog scale (VAS) score from the last follow-up to baseline, and it was analyzed by an inverse-variance, random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale and a funnel plot. RESULTS Of the 4597 studies screened for inclusion, 46 relevant full-text articles were assessed for eligibility. Eleven observational cohort studies from the 46 articles were found to be eligible, and reported on a total of 109 patients. In 86% (94/109) of cases, trial stimulation was successful and followed by a permanent system implantation. VAS scores improved by 75% (mean difference 6.32/10 points, 95% CI 5.38-7.27 points) compared to baseline. Seventy-six percent (42/55) of patients became medication free or required lower doses of medications. The complication rate necessitating surgical revision was estimated at 32% per procedure. CONCLUSIONS These findings support the belief that PNFS provides effective, long-term pain control for trigeminal pain. Statistical heterogeneity was considerable across all studies. Future work should be aimed at conducting double-blind randomized controlled trials to determine the utility of PNFS for treating various forms of trigeminal pain for which limited therapeutic options exist.
Collapse
Affiliation(s)
- Can Sarica
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christian Iorio-Morin
- 2Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Quebec, Canada
| | | | - Michelle Paff
- 4Department of Neurosurgery, University of California, Irvine, Orange, California
| | | | - Artur Vetkas
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 5Department of Neurosurgery, Tartu University Hospital, University of Tartu, Estonia
| | - Kazuaki Yamamoto
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Nardin Samuel
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Vanessa Milano
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Aaron Loh
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Brendan Santyr
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Ajmal Zemmar
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 6Department of Neurosurgery, Henan University School of Medicine, Zhengzhou, China
- 7Department of Neurosurgery, University of Louisville, Kentucky; and
| | - Andres M Lozano
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 8Krembil Research Institute, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada
- 8Krembil Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Zhao L, Song T. Case Report: Short-Term Spinal Cord Stimulation and Peripheral Nerve Stimulation for the Treatment of Trigeminal Postherpetic Neuralgia in Elderly Patients. Front Neurol 2021; 12:713366. [PMID: 34413827 PMCID: PMC8368125 DOI: 10.3389/fneur.2021.713366] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: We aimed to report on the use of short-term high cervical spinal cord stimulation (SCS) combined with peripheral nerve stimulation (PNS) to successfully treat trigeminal postherpetic neuralgia (TPHN) affecting the V2 and V3 divisions. We also sought to use a novel PNS approach to the maxillary nerve next to the external opening of the foramen rotundum (FR) to treat TPHN at the V2 division. Method: Two elderly patients successfully treated with different neuromodulation methods for TPHN are presented in this case series. Results: The first case referred to an 83-year-old Chinese female patient with V2 and V3 TPHN who experienced a significant pain relief using a combination of short-term high cervical SCS at the C1–C2 level and PNS on the infraorbital nerve (ION). Case 2 was a 68-year-old Chinese male patient with V1 and V2 TPHN that obtained an excellent pain relief after having received short-term PNS on the supraorbital nerve (SON), the supratrochlear nerve (STN), and the maxillary nerve. Both reported improvements in their quality of life and ability to perform daily tasks during a 3-month follow-up period. Conclusions: Short-term high cervical SCS at the C1–C2 spinal segments may be a feasible method to treat recent-onset V3 TPHN in elderly patients. Additionally, by placing the stimulation lead next to the external FR opening, we demonstrated a novel PNS approach to the maxillary nerve not previously reported for TPHN therapy.
Collapse
Affiliation(s)
- Lin Zhao
- Department of Pain, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Tao Song
- Department of Pain, The First Affiliated Hospital of China Medical University, Shenyang, China
| |
Collapse
|
5
|
Ni Y, Yang L, Han R, Guo G, Huang S, Weng L, Wang X, Li Z, Huang D, Hu R, Zhou H. Implantable Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain: A Systematic Review and Meta-Analysis. Neuromodulation 2021; 24:983-991. [PMID: 34008282 DOI: 10.1111/ner.13421] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/27/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Implantable peripheral nerve stimulation has been increasingly used to treat neuropathic pain. This neuromodulation strategy may be an alternative option for intractable trigeminal neuropathic pain; however, evidence for this treatment approach remains limited. A systematic review was conducted to identify studies of patients that underwent peripheral nerve stimulation implantation for trigeminal neuropathic pain. MATERIALS AND METHODS Databases including, PubMed, EMBASE, and Cochrane Library were searched up to October 5, 2020. The primary outcomes were changes in pain scores and response rates of neuromodulation therapy. A random effects model was used for meta-analysis. Subgroup analysis was performed to examine the source of heterogeneity. RESULTS Thirteen studies including 221 participants were evaluated. The estimated response rate of neuromodulation treatment was 61.3% (95% CI: 44.4-75.9%, I2 = 70.733%, p < 0.0001) at the last follow-up. The overall reduction in pain scores was 2.363 (95% CI: 1.408-3.319, I2 = 85.723%, p < 0.0001). Subgroup analysis further confirmed that stimulation target (peripheral branch vs. trigeminal ganglion vs. trigeminal nerve root) contributed the heterogeneity across enrolled studies. Better clinical outcome was associated with stimulation of the trigeminal peripheral branch (p < 0.0001). CONCLUSION Peripheral nerve stimulation may be a promising approach in the management of trigeminal neuropathic pain, especially for patients intractable to conventional therapy.
Collapse
Affiliation(s)
- Yuncheng Ni
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Liuqing Yang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Rui Han
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Gangwen Guo
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Shitong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Lili Weng
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Xun Wang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Zhenxing Li
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| | - Rong Hu
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| |
Collapse
|
6
|
Klein J, Siepmann T, Schackert G, Ziemssen T, Juratli TA. Peripheral nerve field stimulation in medically refractory trigeminal neuralgia attributed to multiple sclerosis. J Neurosurg 2021; 134:1244-1250. [DOI: 10.3171/2019.12.jns192261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Case reports and small patient series have suggested peripheral nerve field stimulation (PNFS) as a treatment for refractory trigeminal neuralgia attributed to multiple sclerosis (MS). Here, the authors aimed to assess the effects of this technique on long-term pain severity.
METHODS
Data were prospectively collected on patients with refractory trigeminal neuralgia attributed to MS who underwent PNFS between July 2013 and August 2017 at the authors’ neurosurgical department. Patients were evaluated before and after the first treatment as well as at follow-up at least twice a year. Patients underwent assessment of their pain severity using the Barrow Neurological Institute (BNI) Scale before treatment and at follow-up and were questioned about adverse events following cranial MRI performed after implantation of a permanent PNFS system.
RESULTS
Eight patients (3 women) underwent PNFS trials and their median age was 61 years (IQR 73.75 − 46.5 years). Seven patients proceeded to permanent implantation of the stimulation system. At a median follow-up of 33 months (IQR 42 − 24 months), pain severity decreased from baseline to the last follow-up (BNI score decrease from V [IQR V − V] to III [IQR V − III], p = 0.054). Four patients experienced long-lasting benefit (at 48, 33, 24, and 15 months’ follow-up, respectively), while in 3 patients the treatment eventually failed after an initially successful period. One patient had an infection, requiring system removal and subsequent reimplantation. No other complications occurred. No adverse events were noted in the patients undergoing MRI postimplantation.
CONCLUSIONS
This analysis indicates a possibly beneficial long-term effect of PNFS on refractory trigeminal neuralgia attributed to MS in some patients.
Collapse
Affiliation(s)
- Johann Klein
- 1Department of Neurosurgery, University Hospital Carl Gustav Carus
- 3Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden, Germany
| | - Timo Siepmann
- 2Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden; and
- 3Dresden International University, Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden, Germany
| | | | - Tjalf Ziemssen
- 2Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden; and
| | - Tareq A. Juratli
- 1Department of Neurosurgery, University Hospital Carl Gustav Carus
| |
Collapse
|
7
|
Gupta K, Texakalidis P, Boulis NM. Programming Parameters and Techniques in Trigeminal Ganglion Stimulation for Intractable Facial Pain. Neuromodulation 2020; 24:1100-1106. [PMID: 33145871 DOI: 10.1111/ner.13306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Atypical facial pain syndromes are challenging disorders to manage and often incur limited benefit with surgery for classical trigeminal neuralgia presentations, such as microvascular decompression or ablative procedures. Neurostimulation of the trigeminal ganglion and peripheral nerves can be effective at treating atypical presentations of trigeminal facial pain affecting the V1-3 dermatomes, and the surgical techniques are well described. The stimulation parameters, however, have thus far received limited description; we therefore sought to describe programming strategies. MATERIALS AND METHODS We performed a retrospective chart review, examining patients that underwent trigeminal ganglion stimulation (TGS) and nerve branch stimulation for atypical facial pain and trigeminal neuropathic pain, and describe the programming strategies in detail. RESULTS We describe the use of high-frequency stimulation (1000 Hz), with alteration in pulse width (60-220 msec) and amplitude (0.5-3 V) to achieve effective treatment of refractory trigeminal facial pain. These parameters differ from existing published parameters for trigeminal nerve branch stimulation. We also describe the programming of specific contacts on each lead to target specific aspects of the individual patients' facial pain. CONCLUSIONS The use of effective programming strategies is critical to the success of neurostimulation surgical treatments; however, the critical details in programming strategies typically receive limited description. We report on the use of several successful programming strategies for TGS, to assist pain providers in successfully applying these surgical techniques in these difficult to manage atypical facial pain syndromes.
Collapse
Affiliation(s)
- Kunal Gupta
- Department of Neurological Surgery, Emory University Hospital, Atlanta, GA, USA.,Department of Neurological Surgery, Indiana University Health, Indianapolis, IN, USA
| | - Pavlos Texakalidis
- Department of Neurological Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Nicholas M Boulis
- Department of Neurological Surgery, Emory University Hospital, Atlanta, GA, USA
| |
Collapse
|
8
|
Harland TA, Zbrzeski C, DiMarzio M, Khazen O, Staudt MD, Pilitsis JG. Craniofacial Peripheral Nerve Stimulation: Analysis of a Single Institution Series. Neuromodulation 2020; 23:805-811. [PMID: 32167229 DOI: 10.1111/ner.13145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/08/2020] [Accepted: 02/21/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Objective real-world experience with peripheral nerve stimulation (PNS) is limited. Furthermore, the lack of robust outcome metrics, long-term follow-up and data comparing responders and nonresponders limit the refinement of selection criteria to better identify patients likely to benefit from PNS. MATERIALS AND METHODS We retrospectively analyzed 22 patients with craniofacial pain treated with PNS, and responders were classified as having ≥50% postoperative improvement in the numeric rating scale (NRS). In a subset of patients (n = 11), detailed prospective outcomes metrics were obtained preoperatively and postoperatively, including NRS, Beck Depression Index (BDI), Pain Catastrophizing Scale (PCS), and McGill Pain Questionnaire (MPQ). RESULTS About 59.1% (13 of 22) of subjects were classified as responders at a mean follow-up of 37.5 ± 5.27 months. Diagnoses included migraine (n = 6), occipital neuralgia (n = 9), trigeminal neuropathic pain (TNP; n = 6), and central poststroke pain (n = 1). Within the TNP subgroup, responders were more likely to have undergone two or more trigeminal neuralgia procedures prior to PNS (p < 0.05). In the 11 patients with comprehensive preoperative and postoperative outcome data, we noted significant improvement in NRS (p = 0.0005), BDI (p = 0.04), PCS (p = 0.01), as well as components of PCS (helplessness and magnification, p = 0.02) and MPQ (affective, p = 0.02). CONCLUSIONS The present study adds to the PNS literature by providing long-term data and multiple outcome metrics in a subset of patients. We suggest that BDI, PCS, and MPQ may provide more insight into meaningful response over time. Evaluating functional and quality of life outcomes in patients with craniofacial pain may be more informative than assessing benefit solely based on pain intensity and responder rates.
Collapse
Affiliation(s)
- Tessa A Harland
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Claudia Zbrzeski
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Marisa DiMarzio
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Olga Khazen
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA.,Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| |
Collapse
|
9
|
Kasoff WS, Bina RW. Placement and Anchoring of Trigeminal Neurostimulation Electrodes: Technical Report. Stereotact Funct Neurosurg 2020; 97:285-292. [PMID: 31968343 DOI: 10.1159/000503731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral neurostimulation (PNS) for medically refractory trigeminal and craniofacial pain is an emerging alternative to traditional surgical approaches. Technical problems with craniofacial PNS have included electrode migration and erosion, limiting the utility and cost-effectiveness of this procedure. OBJECTIVE To review our institutional surgical technique for trigeminal PNS implantation, focusing on a novel technique for electrode anchoring. METHODS Consecutive cases of permanent craniofacial PNS placement by a single surgeon over 36 months were reviewed for surgical technique and technical outcomes. Electrodes were placed percutaneously with open anchoring to the pericranium at a separate parietal incision. RESULTS Sixteen systems (53 electrodes) were implanted in 14 patients. Median follow-up was 13 months (range, 5-29 months). Electrode placement was successful in all cases with no intraoperative complications. There was 1 lead migration (6.3% per patient; 1.8% per lead) and no cases of erosion. Two patients (14.3%) required explant for infection, 1 of whom was successfully reimplanted. Three patients (21.4%) underwent surgical revision other than for infection. CONCLUSIONS We present an improved method for craniofacial PNS surgery which introduces a separate incision for electrode anchoring at the parietal boss. This technique simplifies the procedure and greatly reduces rates of erosion and migration, improving patient comfort and satisfaction.
Collapse
Affiliation(s)
- Willard S Kasoff
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA,
| | - Robert W Bina
- Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| |
Collapse
|
10
|
Rohatgi P, Chivukula S, Kashanian A, Bari AA. Peripheral Nerve Stimulation. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
11
|
Banks GP, Winfree CJ. Evolving Techniques and Indications in Peripheral Nerve Stimulation for Pain. Neurosurg Clin N Am 2019; 30:265-273. [PMID: 30898277 DOI: 10.1016/j.nec.2018.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Peripheral nerve stimulation is the direct electrical stimulation of named nerves outside the central neuraxis to alleviate pain in the distribution of the targeted peripheral nerve. These treatments have shown efficacy in treating a variety of neuropathic, musculoskeletal, and visceral refractory pain pathologies; although not first line, these therapies are an important part of the treatment repertoire for chronic pain. With careful patient selection and judicious choice of stimulation technique, excellent results can be achieved for a variety of pain etiologies and distributions. This article reviews current and past practices of peripheral nerve stimulation and upcoming advancements in the field.
Collapse
Affiliation(s)
- Garrett P Banks
- Department of Neurosurgery, Columbia University, 710 West 168 Street, 4th Floor, New York, NY 10032, USA.
| | - Christopher J Winfree
- Department of Neurosurgery, Columbia University, 710 West 168 Street, 4th Floor, New York, NY 10032, USA
| |
Collapse
|
12
|
Gorgulho AA, Fernandes F, Damiani LP, Barbosa DAN, Cury A, Lasagno CM, Bueno PRT, Santos BFO, Santos RHN, Berwanger O, Cavalcanti AB, Teixeira MJ, Moreno RA, De Salles AAF. Double Blinded Randomized Trial of Subcutaneous Trigeminal Nerve Stimulation as Adjuvant Treatment for Major Unipolar Depressive Disorder. Neurosurgery 2018; 85:717-728. [DOI: 10.1093/neuros/nyy420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract
BACKGROUND
More than 30% of major depressive disorder patients fail to respond to adequate trials of medications and psychotherapy. While modern neuromodulation approaches (ie, vagal nerve stimulation, deep brain stimulation) are yet to prove their efficacy for such cases in large randomized controlled trials, trigeminal nerve stimulation (TNS) has emerged as an alternative with promising effects on mood disorders.
OBJECTIVE
To assess efficacy, safety, tolerability, and placebo effect duration of continuous subcutaneous TNS (sTNS) in treatment-resistant depression (TRD).
METHODS
The TREND study is a single-center, double-blind, randomized, controlled, phase II clinical trial. Twenty unipolar TRD patients will receive V1 sTNS as adjuvant to medical therapy and randomized to active vs sham stimulation throughout a 24-wk period. An additional 24-wk open-label phase will follow. Data concerning efficacy, placebo response, relapse, and side effects related to surgery or electrical stimulation will be recorded. We will use the HDRS-17, BDI-SR, IDS_SR30, and UKU scales.
EXPECTED OUTCOMES
The main outcome measure is improvement in depression scores using HAM-17 under continuous sTNS as adjuvant to antidepressants. Active stimulation is expected to significantly impact response and remission rates. Minor side effects are expected due to the surgical procedure and electrical stimulation. The open-label phase should further confirm efficacy and tolerability.
DISCUSSION
This study protocol is designed to define efficacy of a novel adjuvant therapy for TRD. We must strive to develop safe, reproducible, predictable, and well-tolerated neuromodulation approaches for TRD patients impaired to manage their lives and contribute with society.
Collapse
Affiliation(s)
| | - Fernando Fernandes
- Mood Disorders Unit (GRUDA), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Lucas P Damiani
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Daniel A N Barbosa
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
| | - Abrão Cury
- Internal Medicine Department, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Camila M Lasagno
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Priscila R T Bueno
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Bruno F O Santos
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
| | - Renato H N Santos
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Otávio Berwanger
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | | | - Manoel J Teixeira
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
- Neurosurgery Discipline, Neurology Department, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Ricardo A Moreno
- Mood Disorders Unit (GRUDA), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | | |
Collapse
|
13
|
Slavin KV, Yin D, Rasskazoff S. Peripheral Nerve Stimulation for Facial Pain. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00058-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
Spina A, Mortini P, Alemanno F, Houdayer E, Iannaccone S. Trigeminal Neuralgia: Toward a Multimodal Approach. World Neurosurg 2017; 103:220-230. [DOI: 10.1016/j.wneu.2017.03.126] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 01/03/2023]
|
15
|
Sokal P, Harat M, Zieliński P, Kierońska S. Tibial nerve stimulation with a miniature, wireless stimulator in chronic peripheral neuropathic pain. J Pain Res 2017; 10:613-619. [PMID: 28352201 PMCID: PMC5359134 DOI: 10.2147/jpr.s128861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peripheral neuropathic pain (PNP) and complex regional pain syndrome (CRPS) can be effectively treated with peripheral nerve stimulation. In this clinical trial report, effectiveness of novel, miniature, wirelessly controlled microstimulator of tibial nerve in PNP and CRPS was evaluated. In this pilot study the average preoperative visual analog scale (VAS) score in six patients was 7.5, with 1, 3 and 6 months: 2.6 (p=0.03), 1.6 (p=0.03), and 1.3 (p=0.02), respectively. The mean average score in the six patients a week preceding the baseline visit was 7.96, preceding the 1, 3 and 6 month visits: 3.32 (p=0.043), 3.65 (p=0.045), and 2.49 (p=0.002), respectively. The average short-form McGill pain score before surgery was 23.8, and after 1, 3 and 6 months it was 11.0 (p=0.45), 6.3 (p=0.043), and 4.5 (p=0.01), respectively. Applied therapy caused a reduction of pain immediately after its application and clinical improvement was sustained on a similar level in all patients for six months. No complications of the treatment were observed. Intermittent tibial nerve stimulation by using a novel, miniature, wirelessly controlled device can be effective and feasible in PNP and CRPS. It is a safe, minimally invasive, and convenient neuromodulative method.
Collapse
Affiliation(s)
- Paweł Sokal
- Department of Neurosurgery, Military Research Hospital, Bydgoszcz
| | - Marek Harat
- Department of Public Health, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Toruń
| | - Piotr Zieliński
- Department of Sports Medicine, University of Physical Education and Sport, Gdansk, Poland
| | - Sara Kierońska
- Department of Neurosurgery, Military Research Hospital, Bydgoszcz
| |
Collapse
|
16
|
Deer TR, Pope JE. Dorsal root ganglion stimulation approval by the Food and Drug Administration: advice on evolving the process. Expert Rev Neurother 2016; 16:1123-5. [DOI: 10.1080/14737175.2016.1206817] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Abstract
Trigeminal neuralgia is an extremely painful condition. Treatment options for trigeminal neuralgia include anticonvulsants, opioids and surgical methods; however, some cases may be refractory to these therapies. In this article, the authors report a case involving a patient for whom conventional treatments failed; she underwent a successful trial of peripheral nerve stimulation and subsequently opted for a permanent implantation of an internal pulse generator, leading to long-term relief of her pain. Trigeminal neuralgia is a type of orofacial pain that is diagnosed in 150,000 individuals each year, with an incidence of 12.6 per 100,000 person-years and a prevalence of 155 cases per 1,000,000 in the United States. Trigeminal neuralgia pain is characterized by sudden, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, which can cause significant suffering for the affected patient population. In many patients, a combination of medication and interventional treatments can be therapeutic, but is not always successful. Peripheral nerve stimulation has gained popularity as a simple and effective neuromodulation technique for the treatment of many pain conditions, including chronic headache disorders. Specifically in trigeminal neuralgia, neurostimulation of the supraorbital and infraorbital nerves may serve to provide relief of neuropathic pain by targeting the distal nerves that supply sensation to the areas of the face where the pain attacks occur, producing a field of paresthesia within the peripheral distribution of pain through the creation of an electric field in the vicinity of the leads. The purpose of the present case report is to introduce a new, less-invasive interventional technique, and to describe the authors’ first experience with supraorbital and infraorbital neurostimulation therapy for the treatment of trigeminal neuralgia in a patient who had failed previous conservative management.
Collapse
|
18
|
Klein J, Sandi-Gahun S, Schackert G, Juratli TA. Peripheral nerve field stimulation for trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain. Cephalalgia 2015. [DOI: 10.1177/0333102415597526] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Peripheral nerve field stimulation (PNFS) is a promising modality for treatment of intractable facial pain. However, evidence is sparse. We are therefore presenting our experience with this technique in a small patient cohort. Methods Records of 10 patients (five men, five women) with intractable facial pain who underwent implantation of one or several subcutaneous electrodes for trigeminal nerve field stimulation were retrospectively analyzed. Patients’ data, including pain location, etiology, duration, previous treatments, long-term effects and complications, were evaluated. Results Four patients suffered from recurrent classical trigeminal neuralgia, one had classical trigeminal neuralgia and was medically unfit for microvascular decompression. Two patients suffered from trigeminal neuropathy attributed to multiple sclerosis, one from post-herpetic neuropathy, one from trigeminal neuropathy following radiation therapy and one from persistent idiopathic facial pain. Average patient age was 74.2 years (range 57–87), and average symptom duration was 10.6 years (range 2–17). Eight patients proceeded to implantation after successful trial. Average follow-up after implantation was 11.3 months (range 5–28). Using the visual analog scale, average pain intensity was 9.3 (range 7–10) preoperatively and 0.75 (range 0–3) postoperatively. Six patients reported absence of pain with stimulation; two had only slight constant pain without attacks. Conclusion PNFS may be an effective treatment for refractory facial pain and yields high patient satisfaction.
Collapse
Affiliation(s)
- Johann Klein
- Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sahr Sandi-Gahun
- Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tareq A Juratli
- Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
19
|
Ellis JA, Mejia Munne JC, Winfree CJ. Trigeminal branch stimulation for the treatment of intractable craniofacial pain. J Neurosurg 2015; 123:283-8. [DOI: 10.3171/2014.12.jns14645] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Trigeminal branch stimulation has been used in the treatment of craniofacial pain syndromes. The risks and benefits of such an approach have not been clearly delineated in large studies, however. The authors report their experience in treating craniofacial pain with trigeminal branch stimulation and share the lessons they have learned after 93 consecutive electrode placements.
METHODS
A retrospective review of all patients who underwent trigeminal branch electrode placement by the senior author (C.J.W.) for the treatment of craniofacial pain was performed.
RESULTS
Thirty-five patients underwent implantation of a total of 93 trial and permanent electrodes between 2006 and 2013. Fifteen patients who experienced improved pain control after trial stimulation underwent implantation of permanent stimulators and were followed for an average of 15 months. At last follow-up 73% of patients had improvement in pain control, whereas only 27% of patients had no pain improvement. No serious complications were seen during the course of this study.
CONCLUSIONS
Trigeminal branch stimulation is a safe and effective treatment for a subset of patients with intractable craniofacial pain.
Collapse
|
20
|
Goldberg SW, Nahas SJ. Supratrochlear and Supraorbital Nerve Stimulation for Chronic Headache: a Review. Curr Pain Headache Rep 2015; 19:26. [DOI: 10.1007/s11916-015-0496-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
21
|
Deer TR, Mekhail N, Petersen E, Krames E, Staats P, Pope J, Saweris Y, Lad SP, Diwan S, Falowski S, Feler C, Slavin K, Narouze S, Merabet L, Buvanendran A, Fregni F, Wellington J, Levy RM. The appropriate use of neurostimulation: stimulation of the intracranial and extracranial space and head for chronic pain. Neuromodulation Appropriateness Consensus Committee. Neuromodulation 2015; 17:551-70; discussion 570. [PMID: 25112890 DOI: 10.1111/ner.12215] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 04/17/2014] [Accepted: 05/13/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain. METHODS The INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods. The literature searches involved key word searches in PubMed, EMBASE, and Google Scholar dated 1970-2013, which were graded and evaluated by the authors. RESULTS The NACC found that evidence supports extracranial stimulation for facial pain, migraine, and scalp pain but is limited for intracranial neuromodulation. High cervical spinal cord stimulation is an evolving option for facial pain. Intracranial neurostimulation may be an excellent option to treat diseases of the nervous system, such as tremor and Parkinson's disease, and in the future, potentially Alzheimer's disease and traumatic brain injury, but current use of intracranial stimulation for pain should be seen as investigational. CONCLUSIONS The NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible.
Collapse
|
22
|
Lerman IR, Chen JL, Hiller D, Souzdalnitski D, Sheean G, Wallace M, Barba D. Novel High-Frequency Peripheral Nerve Stimulator Treatment of Refractory Postherpetic Neuralgia: A Brief Technical Note. Neuromodulation 2015; 18:487-93; discussion 493. [PMID: 25832898 DOI: 10.1111/ner.12281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/14/2015] [Accepted: 01/21/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study aims to describe an ultrasound (US)-guided peripheral nerve stimulation implant technique and describe the effect of high-frequency peripheral nerve stimulation on refractory postherpetic neuralgia. MATERIALS AND METHODS Following a cadaver pilot trial using US and confirmatory fluoroscopic guidance, a 52-year-old man with refractory left supraorbital neuralgia underwent combined US and fluoroscopic-guided supraorbital peripheral nerve stimulator trial. The patient was subsequently implanted with a percutaneous lead over the left supraorbital and supratrochlear nerve utilizing a high-frequency stimulation paradigm. RESULTS At 9 months follow-up, the pain intensity had declined from a weekly average of 8/10 to 1/10 on the pain visual analog scale (VAS). After implant, both nerve conduction and blink reflex studies were performed, which demonstrated herpetic nerve damage and frequency-specific peripheral nerve stimulation effects. The patient preferred analgesia in the supraorbital nerve distribution accomplished with high-frequency paresthesia-free stimulation (HFS) at an amplitude of 6.2 mA, a frequency of 100-1200 Hz, and a pulse width of 130 μsec, to paresthesia-mediated pain relief associated with low-frequency stimulation. CONCLUSION We report the implant of a supraorbital peripheral nerve stimulating electrode that utilizes a high-frequency program resulting in sustained suppression of intractable postherpetic neuralgia.
Collapse
Affiliation(s)
| | | | - David Hiller
- University of California San Diego, San Diego, CA, USA
| | | | | | - Mark Wallace
- University of California San Diego, San Diego, CA, USA
| | - David Barba
- University of California San Diego, San Diego, CA, USA
| |
Collapse
|
23
|
Shaw A, Sharma M, Deogaonkar M, Rezai A. Technological innovations in implants used for pain therapies. Neurosurg Clin N Am 2014; 25:833-42. [PMID: 25240670 DOI: 10.1016/j.nec.2014.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The field of pain management has experienced tremendous growth in implantable therapies secondary to the innovations of bioengineers, implanters, and industry. Every aspect of neuromodulation is amenable to innovation from implanting devices to anchors, electrodes, programming, and even patient programmers. Patients with previously refractory neuropathic pain syndromes have new and effective pain management strategies that are a direct result of innovations in implantable devices.
Collapse
Affiliation(s)
- Andrew Shaw
- Department of Neurological Surgery, Wexner Medical Center, Center for Neuromodulation, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - Mayur Sharma
- Department of Neurological Surgery, Wexner Medical Center, Center for Neuromodulation, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - Milind Deogaonkar
- Department of Neurological Surgery, Wexner Medical Center, Center for Neuromodulation, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - Ali Rezai
- Department of Neurological Surgery, Wexner Medical Center, Center for Neuromodulation, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA.
| |
Collapse
|
24
|
Shaw A, Mohyeldin A, Zibly Z, Ikeda D, Deogaonkar M. Novel Tunneling System for Implantation of Percutaneous Nerve Field Stimulator Electrodes: A Technical Note. Neuromodulation 2014; 18:313-6; discussion 316. [DOI: 10.1111/ner.12224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/21/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Shaw
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| | - Ahmed Mohyeldin
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| | - Zion Zibly
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| | - Daniel Ikeda
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| | - Milind Deogaonkar
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| |
Collapse
|
25
|
Vaisman J, Lopez E, Muraoka NK. Supraorbital and supratrochlear stimulation for trigeminal autonomic cephalalgias. Curr Pain Headache Rep 2014; 18:409. [PMID: 24562664 DOI: 10.1007/s11916-014-0409-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Trigeminal autonomic cephalalgias (TAC) is a rare primary headache disorder with challenging and limited treatment options for those unfortunate patients with severe and refractory pain. This article will review the conventional pharmacologic treatments as well as the new neuromodulation techniques designed to offer alternative and less invasive treatments. These techniques have evolved from the treatment of migraine headache, a much more common headache syndrome, and expanded towards application in patients with TAC. Specifically, the article will discuss the targeting of the supratrochlear and supraorbital nerves, both terminal branches of the trigeminal nerve.
Collapse
Affiliation(s)
- Julien Vaisman
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA,
| | | | | |
Collapse
|
26
|
Reverberi C, Dario A, Barolat G, Zuccon G. Using Peripheral Nerve Stimulation (PNS) to Treat Neuropathic Pain: A Clinical Series. Neuromodulation 2014; 17:777-83; discussion 783. [DOI: 10.1111/ner.12157] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 09/07/2013] [Accepted: 12/20/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Giancarlo Barolat
- Neuroscience Division; St. Luke Presbyterian Hospital; Denver CO USA
| | - Giulia Zuccon
- Barolat Neuroscience; Presbyterian/St Lukes Medical Center; Denver CO USA
| |
Collapse
|
27
|
Deogaonkar M, Slavin KV. Peripheral Nerve/Field Stimulation for Neuropathic Pain. Neurosurg Clin N Am 2014; 25:1-10. [DOI: 10.1016/j.nec.2013.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Verrills P, Rose R, Mitchell B, Vivian D, Barnard A. Peripheral Nerve Field Stimulation for Chronic Headache: 60 Cases and Long-Term Follow-Up. Neuromodulation 2013; 17:54-9. [DOI: 10.1111/ner.12130] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 06/21/2013] [Accepted: 08/27/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Rebecca Rose
- Metro Spinal Clinic; Caulfield South Vic. Australia
| | | | - David Vivian
- Metro Spinal Clinic; Caulfield South Vic. Australia
| | | |
Collapse
|
29
|
Pope JE, Deer TR, Kramer J. A systematic review: current and future directions of dorsal root ganglion therapeutics to treat chronic pain. PAIN MEDICINE 2013; 14:1477-96. [PMID: 23802747 DOI: 10.1111/pme.12171] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of the study was to systematically review the historical therapeutics for chronic pain care directed at the dorsal root ganglion (DRG) and to identify future trends and upcoming treatment strategies. METHODS A literature search on bibliographic resources, including EMBASE, PubMed Cochrane Database of Systemic Reviews from literature published from 1966 to December 1, 2012 to identify studies and treatments directed at the DRG to treat chronic pain, and was limited to the English language. Case series, case reports, and preclinical work were excluded. Information on emerging technologies and pharmacologics were captured separately, as they did not meet the inclusion criteria. RESULTS The literature review yielded three current clinical treatment strategies: ganglionectomy, conventional radiofrequency treatment of the dorsal root ganglion, and pulsed radiofrequency treatment of the DRG. Seven studies were identified utilizing ganglionectomy, 14 for conventional radiofrequency, and 16 for pulsed radiofrequency. Electrical stimulation and novel therapeutic delivery strategies have been proposed and are in development. CONCLUSIONS Despite a robust understanding of the DRG and its importance in acute nociception, as well as the development and maintenance of chronic pain, relatively poor evidence exists regarding current therapeutic strategies. Novel therapies like electrical and pharmacologic strategies are on the horizon, and more prospective study is required to better qualify the role of the DRG in chronic pain care.
Collapse
Affiliation(s)
- Jason E Pope
- The Center for Pain Relief, Charleston, West Virginia
| | | | | |
Collapse
|
30
|
Yakovlev AE, Peterson AT. Peripheral nerve stimulation in treatment of intractable postherpetic neuralgia. Neuromodulation 2012; 10:373-5. [PMID: 22150898 DOI: 10.1111/j.1525-1403.2007.00126.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective. This case report presents an application of peripheral nerve stimulation to a patient with intractable postherpetic neuralgia that conventional treatment failed to ameliorate. Methods. The patient underwent an uneventful peripheral nerve stimulator trial with placement of two temporal eight-electrode percutaneous leads (Octrode leads, Advanced Neuromodulation Systems, Plano, TX, USA) into the right subscapular and right paraspinal area of the upper thoracic region. Results. Upon experiencing excellent pain relief over the next two weeks, the patient underwent implantation of permanent leads two weeks later and reported sustained pain relief. Conclusion. Peripheral nerve stimulation offers an alternative treatment option for intractable pain associated with postherpetic neuralgia, especially for elderly patients where treatment options are limited due to existing comorbidities. Further studies are warranted.
Collapse
Affiliation(s)
- Alexander E Yakovlev
- Interventional Pain Management and Physical Medicine, Marshfield Clinic, Marshfield, WI, USA
| | | |
Collapse
|
31
|
Vaisman J, Markley H, Ordia J, Deer T. The Treatment of Medically Intractable Trigeminal Autonomic Cephalalgia With Supraorbital/Supratrochlear Stimulation: A Retrospective Case Series. Neuromodulation 2012; 15:374-80. [DOI: 10.1111/j.1525-1403.2012.00455.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Van Buyten JP, Linderoth B. Invasive neurostimulation in facial pain and headache syndromes. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2011.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Mammis A, Gudesblatt M, Mogilner AY. Peripheral Neurostimulation for the Treatment of Refractory Cluster Headache, Long-Term Follow-Up: Case Report. Neuromodulation 2011; 14:432-5; discussion 435. [DOI: 10.1111/j.1525-1403.2011.00386.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Yakovlev AE, Resch BE, Yakovleva VE. Peripheral Nerve Field Stimulation in the Treatment of Postlaminectomy Syndrome after Multilevel Spinal Surgeries. Neuromodulation 2011; 14:534-8; discussion 538. [DOI: 10.1111/j.1525-1403.2011.00387.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
35
|
Tomycz ND, Deibert CP, Moossy JJ. Cervicomedullary Junction Spinal Cord Stimulation for Head and Facial Pain. Headache 2011; 51:418-425. [DOI: 10.1111/j.1526-4610.2010.01829.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Yakovlev AE, Resch BE. Treatment of Chronic Intractable Hip Pain After Iliac Crest Bone Graft Harvest Using Peripheral Nerve Field Stimulation. Neuromodulation 2011; 14:156-9; discussion 159. [DOI: 10.1111/j.1525-1403.2010.00322.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Lynch PJ, McJunkin T, Eross E, Gooch S, Maloney J. Case report: successful epiradicular peripheral nerve stimulation of the C2 dorsal root ganglion for postherpetic neuralgia. Neuromodulation 2010; 14:58-61; discussion 61. [PMID: 21992163 DOI: 10.1111/j.1525-1403.2010.00307.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common complication following an acute varicella zoster virus infection. PHN often results in a chronic severe pain condition refractory to conservative pain management treatments. Peripheral nerve stimulation over the affected spinal nerve root may be an effective treatment option for patients with intractable PHN. OBJECTIVE To describe a successful case of peripheral nerve stimulation of the second cervical dorsal root ganglion for the treatment of intractable PHN. CASE REPORT An 80-year-old man with a 15-month history of severe PHN was referred to our clinic for pain management. His pain was localized to the left side in the distribution of the C2 dermatome. The patient's pain was unresponsive to comprehensive conventional treatments for PHN including physical therapy, membrane stabilizing medications, opioids, anti-inflammatories, cervical epidural steroid injections, cervical facet joint injections, and dorsal root ganglion blockade with pulsed radiofrequency. After failing to respond to conservative and interventional therapies, a peripheral nerve stimulator trial was conducted for a period of seven days. The lead was placed within the epidural space over the atlanto-axial joint under fluoroscopy to stimulate the left C2 nerve root. This trial resulted in a significant decrease of the patient's pain, and discontinuation of all pain medications. CONCLUSION We describe a case of successful electrode placement at the C2 spinal level for the treatment of refractory PHN.
Collapse
Affiliation(s)
- Paul J Lynch
- Mayo Clinic College of Medicine, Scottsdale, AZ 85258, USA.
| | | | | | | | | |
Collapse
|
38
|
Slavin KV, Vannemreddy PSSV. Repositioning of supraorbital nerve stimulation electrode using retrograde needle insertion: a technical note. Neuromodulation 2010; 14:160-3; discussion 163-4. [PMID: 21992205 DOI: 10.1111/j.1525-1403.2010.00315.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With growing interest and acceptance of peripheral nerve stimulation (PNS) approach, there is now an increasing need in developing clear procedural details to resolve frequent complications and minimize associated tissue injury. Migration and suboptimal positioning of PNS electrodes are one of the most commonly observed complications of PNS approach. MATERIALS AND METHODS We present a simple technique for repositioning a supraorbital electrode using retrograde insertion of introducer needle that allows one to place percutaneous (cylindrical) PNS electrode into appropriate anatomical location with minimal additional injury to surrounding tissues. RESULTS This approach has been successfully used in multiple cases. An illustrative case of electrode revision with proposed technique is described in detail. CONCLUSION This technically simple approach to repositioning of cylindrical supraorbital electrodes using retrograde needle insertion eliminates the need for a more elaborate and invasive procedure. The technique can be used for electrode repositioning in most PNS applications.
Collapse
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | |
Collapse
|
39
|
Prospective clinical study of a new implantable peripheral nerve stimulation device to treat chronic pain. Clin J Pain 2010; 26:359-72. [PMID: 20473041 DOI: 10.1097/ajp.0b013e3181d4d646] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate clinical use of the StimRouter, an investigational implanted peripheral nerve stimulator for treating chronic neuropathic pain, using the median nerve as a model for that general application. METHODS Eight patients with carpal tunnel syndrome and chronic pain despite both carpal tunnel release and treatment with oral pain medications were enrolled in a single-center, open-label trial after institutional review board approval. Primary endpoints were successful implantation near the target peripheral nerve and safety. All 8 patients were implanted temporarily at the median nerve in at least one arm and 2 patients were implanted bilaterally, with 10 implants total. Each implant was considered a separate "patient." For 5 days, all patients received 6 hours of daily transdermal electrical stimulation targeting the median nerve. Pain was measured at baseline, during implant, and after explant. RESULTS Two patients experienced clinically meaningful (>or=30%) pain reduction throughout the entire 5-day treatment period. Apparent carryover effect in pain reduction also was observed after daily stimulation. After explant, pain returned to baseline, increasing 36.8% to 45.6% relative to average reduced pain with daily stimulation. No significant or unexpected adverse events occurred. Mean patient study satisfaction was 96%, and 100% of patients indicated a preference for permanent implant. DISCUSSION Temporary implant of the StimRouter device resulted in both pain reduction and reduced use of oral opioid pain medication during the 5-day stimulation period. The results suggest that permanent implant of the StimRouter System may be safe and effective for treating chronic peripheral neuropathic pain.
Collapse
|
40
|
Goyal GN, Gupta D, Jain R, Kumar S, Mishra S, Bhatnagar S. Peripheral Nerve Field Stimulation for Intractable Post-Thoracotomy Scar Pain not Relieved by Conventional Treatment. Pain Pract 2010; 10:366-9. [DOI: 10.1111/j.1533-2500.2010.00363.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
41
|
Yakovlev AE, Resch BE. Treatment of chronic intractable atypical facial pain using peripheral subcutaneous field stimulation. Neuromodulation 2010; 13:137-40. [DOI: 10.1111/j.1525-1403.2009.00249.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
42
|
Surjya Prasad Upadhyay, Shiv Pratap Rana, Mishra S, Bhatnagar S. Successful treatment of an intractable postherpetic neuralgia (PHN) using peripheral nerve field stimulation (PNFS). Am J Hosp Palliat Care 2009; 27:59-62. [PMID: 19700650 DOI: 10.1177/1049909109342089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome that arises as a sequel of herpes zoaster eruption. The treatment of postherpetic neuralgia is medically challenging and often frustrating in some situation as the exact mechanism of neuralgia is poorly understood and multiple and complex pathophysiology is postulated requiring poly pharmacy, which itself leads to many side effects. Here, we present a successful management of supra-orbital PHN using peripheral nerve field stimulation (PNFS), which was refractory to the commonly used pharmacological treatment. After successful trial stimulation, permanent stimulator was placed successfully, patient medication were tapered off within 2 weeks. At present, patient is in 8-week poststimulation with excellent pain relief, without any side effect.
Collapse
Affiliation(s)
- Surjya Prasad Upadhyay
- Department of Anaesthesiology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | |
Collapse
|
43
|
Reverberi C, Bonezzi C, Demartini L. Peripheral Subcutaneous Neurostimulation in the Management of Neuropathic Pain: Five Case Reports. Neuromodulation 2009; 12:146-55. [DOI: 10.1111/j.1525-1403.2009.00201.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
44
|
Kouroukli I, Neofytos D, Panaretou V, Zompolas V, Papastergiou D, Sanidas G, Papavassilopoulou T, Georgiou L. Peripheral subcutaneous stimulation for the treatment of intractable postherpetic neuralgia: two case reports and literature review. Pain Pract 2009; 9:225-9. [PMID: 19226314 DOI: 10.1111/j.1533-2500.2009.00263.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Postherpetic neuralgia (PHN) is a common cause of chronic pain in the elderly. Antidepressants, anticonvulsants, and opioids may reduce discomfort in many patients, while others have pain intractable to all forms of therapy. We present a novel treatment approach for intractable PHN utilizing percutaneous peripheral nerve stimulation. Two cases are described in which an 80-year-old man and a 67-year-old woman with intractable PHN, lasting 2 and 10 years, respectively, were effectively treated with implantation of two octapolar leads in the lateral thoracic region. These cases suggest that peripheral nerve stimulation may offer an alternative treatment option for intractable pain associated with PHN especially in the elderly where treatment options are limited because of existing comorbidities.
Collapse
Affiliation(s)
- Irene Kouroukli
- Department of Anaesthesiology and Pain Clinic, Hippocratio General Hospital, Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Stuart RM, Winfree CJ. Neurostimulation Techniques for Painful Peripheral Nerve Disorders. Neurosurg Clin N Am 2009; 20:111-20, vii-viii. [DOI: 10.1016/j.nec.2008.07.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
46
|
Bernstein CA, Paicius RM, Barkow SH, Lempert-Cohen C. Spinal Cord Stimulation in Conjunction With Peripheral Nerve Field Stimulation for the Treatment of Low Back and Leg Pain: A Case Series. Neuromodulation 2008; 11:116-23. [DOI: 10.1111/j.1525-1403.2008.00152.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
47
|
Abstract
Peripheral nerve stimulation (PNS) has been used for treatment of neuropathic pain for more than 40 years. Recent resurgence of interest to this elegant surgical modality came from the introduction of less invasive implantation techniques and the wider acceptance of neuromodulation as a treatment of medically refractory cases. This article reviews the literature on the use of PNS for neuropathic pain and describes current indications and hardware choices in frequent use. Published experience indicates that neuropathic pain responds to PNS in many patients. PNS works well in both established indications, such as post-traumatic and postsurgical neuropathy, occipital neuralgia, and complex regional pain syndromes, and in relatively new indications for neuromodulation, such as migraines and daily headaches, cluster headaches, and fibromyalgia. Future research and growing clinical experience will help in identifying the best candidates for PNS, choosing the best procedure and best hardware for each individual patient, and defining adequate expectations for patients and pain specialists.
Collapse
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
| |
Collapse
|
48
|
Neuromodulación quirúrgica. Nuevos horizontes en Neurocirugía. Neurocirugia (Astur) 2008. [DOI: 10.1016/s1130-1473(08)70238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
Slavin KV, Nersesyan H, Colpan ME, Munawar N. Current algorithm for the surgical treatment of facial pain. Head Face Med 2007; 3:30. [PMID: 17651504 PMCID: PMC1976607 DOI: 10.1186/1746-160x-3-30] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Accepted: 07/25/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Facial pain may be divided into several distinct categories, each requiring a specific treatment approach. In some cases, however, such categorization is difficult and treatment is ineffective. We reviewed our extensive clinical experience and designed an algorithmic approach to the treatment of medically intractable facial pain that can be treated through surgical intervention. METHODS Our treatment algorithm is based on taking into account underlying pathological processes, the anatomical distribution of pain, pain characteristics, the patient's age and medical condition, associated medical problems, the history of previous surgical interventions, and, in some cases, the results of psychological evaluation. The treatment modalities involved in this algorithm include diagnostic blocks, peripheral denervation procedures, craniotomy for microvascular decompression of cranial nerves, percutaneous rhizotomies using radiofrequency ablation, glycerol injection, balloon compression, peripheral nerve stimulation procedures, stereotactic radiosurgery, percutaneous trigeminal tractotomy, and motor cortex stimulation. We recommend that some patients not receive surgery at all, but rather be referred for other medical or psychological treatment. RESULTS Our algorithmic approach was used in more than 100 consecutive patients with medically intractable facial pain. Clinical evaluations and diagnostic workups were followed in each case by the systematic choice of the appropriate intervention. The algorithm has proved easy to follow, and the recommendations include the identification of the optimal surgery for each patient with other options reserved for failures or recurrences. Our overall success rate in eliminating facial pain presently reaches 96%, which is higher than that observed in most clinical series reported to date CONCLUSION This treatment algorithm for the intractable facial pain appears to be effective for patients with a wide variety of painful conditions and may be recommended for use in other institutions.
Collapse
Affiliation(s)
- Konstantin V Slavin
- Section of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Hrachya Nersesyan
- Section of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Mustafa E Colpan
- Section of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| | - Naureen Munawar
- Section of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of Illinois Medical Center at Chicago, Chicago, Illinois, USA
| |
Collapse
|
50
|
Narouze SN, Kapural L. Supraorbital Nerve Electric Stimulation for the Treatment of Intractable Chronic Cluster Headache: A Case Report. Headache 2007; 47:1100-2. [PMID: 17635606 DOI: 10.1111/j.1526-4610.2007.00869.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a patient with intractable chronic cluster headache that responded well to supraorbital nerve electric stimulation.
Collapse
Affiliation(s)
- Samer N Narouze
- Pain Management Department, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | |
Collapse
|